Lynn Senftner talks about the loss of their son Tate to suicide on new years day in Onida, SD January 30, 2012. / Melissa Sue Gerrits / Argus Leader

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Leading causes of death

Suicide was the second leading cause of death for South Dakotans ages 15 to 24 from 2005 through 2010, according to the state Health Department. Here is how the top five categories break down in that time period: Accidents … 307 Suicide … 182 Homicide … 29 Cancer … 20 Heart disease … 11 Here is a year-by-year breakdown of suicides in the decades of the 2000s, according to the state Health Department. There were 139 suicides in 2010: 2000 … 95 2001 … 108 2002 … 94 2003 … 103 2004 … 114 2005 … 123 2006 … 125 2007 … 101 2008 … 123 2009 … 128 Among the most acute signs that someone is pondering suicide are actions in which they: • Threaten to hurt or kill themselves, or talk of wanting to hurt or kill themselves. • Look for ways to kill themselves by seeking access to firearms, available pills or other means. • Talk or write about death, dying or suicide when such behavior is out of the ordinary. Other warning signs include

• Increased alcohol or drug use • Feeling there is no reason to live or no purpose in life • Anxiety, agitation, unable to sleep or sleeping all the time • Feeling trapped, like there’s no way out • Hopelessness • Withdrawal from friends, family and society • Rage, uncontrolled anger or seeking revenge • Acting reckless or engaging in risky activities, seemingly without thinking • Dramatic mood changes Source: American Association of SuicidologySurvivors of suicide – described as a family member or friend -- represent “the largest mental health casualties related to suicide,” according to the American Association of Suicidology. With more than 36,000 suicides annually in the United States, AAS estimates that there are at least six survivors for every suicide, though that is believed to be a conservative number. Based on the six survivors per suicide estimate, approximately 6 million Americans became survivors of suicide in the past 25 years. The HelpLine Center in Sioux Falls offers a monthly grief support group for anyone who has lost a loved one to suicide. The group meets the first Thursday of each month from 7 to 8:30 p.m. at the Non-Profit Center, 1000 N. West Ave., Suite 310. There is no charge for the group, registration is not required and any survivor who is interested is welcome. The group is facilitated by a social worker who also is a survivor. For more information, call (605) 339-4357, or email sandy@helplinecenter.org or lori@helplinecenter.orgTeenagers at 23 high schools in South Dakota needing support as they deal with depression, suicidal thoughts or family programs are able to get that help through a new texting option offered by the Help-Line Center in Sioux Falls. The crisis texting program is currently available to teens from 3 to 11 p.m. daily. Teens can text the keyword “icare” to 839863 to receive that assistance.

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ONIDA — At the moment they chose death — in a haymow, in a car, in a dorm room, at the family’s front step — Ty Kruger, Nicole Vallie Harris, Connor Noteboom and Tate Senftner simply wanted to end the pain.

Hurting others? Changing lives forever? Leaving loved ones to break down in tears at the most inexplicable moments? Those in the throes of suicidal ideations probably don’t give that much thought, experts say. If they do, they think their loved ones’ pain will be short lived, or that everyone will be better off when they are gone. But those left behind after suicide would say this to every troubled soul standing at the abyss, ready to step off: You are wrong.

“I’m not a professional; I’m just talking as a mother,” said Janine Harris of Sioux Falls, whose 20-year-old daughter, Nicole, died June 15, 2005, in her car on a gravel road north of the Badlands. “But I have to believe the state of depression … is so dark and gloomy and like a tunnel vision that they really don’t think or see beyond that. They don’t see the pain they’ll be inflicting.”

That pain spreads across more lives than those dying by their own hands could imagine. But unlike the past, when the stigma of suicide left survivors to suffer alone with their sorrow, an awakening of understanding and support billows today across South Dakota.

In survivor support groups, and in emerging community awareness activities, the veil of shame that would crush souls already wounded by the act of their loved ones slowly is lifting. That’s because people seeking healing in their lives are finding it in the shared experiences of others who know their story and their suffering.

At a walk last summer at Falls Park for survivors of suicide, for example, organizers from the HelpLine Center anticipated a crowd of 200 to 300 participants. They knew the wounded were out there; they just didn’t anticipate so many. More than 750 people showed up.

“I was sad to see there were that many people affected by suicide,” said Karen Krietlow, a participant in the walk from Baltic whose brother-in-law, Jimmy Krietlow, died by suicide eight years ago. “But it was nice to see all those people, and that they had found a place where it was OK to talk about it.”

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Suicide is a difficult conversation for anyone left to struggle with an act that often is so inexplicable. For Jerry Cook of Brandon, Mondays were the worst. When he was growing up, he would come back to school after the weekend and listen to buddies talk about going fishing or hunting or to ballgames with their dads. His father killed himself at their Topeka, Kan., home when Cook was 5.

“As you get to your middle teenage years, you start to really deal with and understand the stigma that goes along with mental illness,” he said. “When you say things like, ‘My dad took his life or died by suicide,’ you get kind of this glossed over look, or everybody sort of retracts. It’s typically a pretty short conversation.”

Several weeks ago, Lynette Kruger returned to her George, Iowa, farmhouse to find a voicemail from a man asking her farmer-real estate agent husband for help in selling a place in town. He didn’t know that Ty Kruger had killed himself four Junes ago in the haymow out in his barn.

“I thought, ‘Oh, boy, here I have to go. I have to talk about this a little bit,’ ” Lynette Kruger, 59, recalled. “And that one time, they didn’t ask what happened? Or how did he die? I didn’t have to go through all that. At the time, I wasn’t really feeling like I wanted to share.”

But sharing can be some of the best medicine for those left behind, officials at the HelpLine Center say. Studies suggest that suffering in silence and avoiding the subject creates even more long-term heartache and problems for people who, because of their relationship to a suicide victim, can become more disposed to considering the act themselves some day.

Risk higher for survivors

“What happens when you lose a family member to suicide is, that option is put in front of you as a coping strategy for emotional pain,” Janet Kittams-Lalley, executive director of the HelpLine Center, said. “So those left behind definitely are at higher risk.”

To mitigate some of those potential outcomes, the center encourages survivors to journal on what they are thinking and feeling. It invites survivors to join support groups that meet monthly in its offices at the Non-Profit Center at 1000 N. West Ave. in Sioux Falls. In that setting, Kruger and Cook say, participants learn that they aren’t alone. They discover that their feelings of struggle and grief are validated. They find others who understand when it is difficult for them to even say the word “suicide.”

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A support group is one coping mechanism. Others say they find healing in private counseling, or in other support-group settings such as that offered through a program staged in area churches called GriefShare. Faith helps to dry the tears, too. Most important, perhaps, is family support.

“My mother-in-law and I would get together and talk about it a lot,” Krietlow said of her brother-in-law’s death. “We would go to the cemetery and sit and just talk, I guess, with Jimmy and with each other. That really helped me.”

Healing after pain fades

The pain will subside in time, Krietlow and other survivors say, but lives never are the same after a suicide. It’s like a scar replaces the wound to a heart but remains as a forever reminder.

In a message he left behind in his laptop computer, 19-year-old Connor Noteboom apologized before taking his life last Dec. 11 in his Binnewies Hall dorm room at South Dakota State University. He talked about his own emotional pain, but he couldn’t begin to understand in his apology the pain and confusion he was leaving them, Craig and Jenny Noteboom said.

“Even with the little things,” said Jenny Noteboom, who works as a school counselor in Wagner. “I had to introduce myself to a new class when I went back to school after Connor’s death. Usually I’d say I have a son in college and a daughter in school here. But that kind of messed me up. I don’t know what to say anymore.”

Grief mixes with anger

In Onida, where a gunshot ended Tate Senftner’s life this past New Year’s Day outside the front door of his family’s home, his mother struggles with trying to forgive her son for such a senseless act versus how difficult it is to be angry at a young man she loved so much.

“I sit late at night and think about it,” Lynn Senftner, 49, said. “You play back every single minute of his last days. You go back and think about how sad he must have been, or what you didn’t do to take care of him. That’s your job as a parent.”

Constant revisiting of “what if” is common for survivors left behind after suicide. Nine out of 10 times, those who die by their own hands probably had a diagnosable mental health issue, Kittams-Lalley said, whether they were bipolar, depressed, suffering from anxiety disorders or substance-abuse issues. Many families know that and still can’t stop the act. Others keep going back, agonizing over every detail they didn’t recognize then.

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On the Rosebud reservation, Angel Wilson’s son, Clay, struggled for years with what she thinks was a chemical imbalance in his brain. He was prescribed drugs but didn’t like to take them, she said. Without them, he couldn’t ward off the grind of reservation life that included gang pressures and rampant suicide among his friends.

Her son took his life Jan. 24, 2007, just days after his 19th birthday.

“You want to do whatever you can to keep it from happening,” she continued. “But on the emotional side, you do think about what will happen, or that someday I could lose him.”

Warning signs and guilt

If Angel Wilson had a sense of the potential outcome of her son’s downward spiral, Mary Ellen Dirksen said she was blind to the possibility, even though her brother, Rob, was on medication for an anxiety disorder and had begun to change in appearance and attitude up to a year before he died by suicide July 17, 2005.

They had grown up together in Little Rock, Iowa, had passed from their youth into adulthood as more than just brother and sister, but as the best of friends, and had shared wonderful conversations as they traveled together to law school at the University of South Dakota, Dirksen said.

When Rob was a sophomore in college, their grandmother died. That might have been the beginning of the change, Dirksen said. “He started to play this thing of, ‘Why do people die? Why do we have to be left alone without the people we love,’ ” she recalled. “He just really was having a lot of questions about her death.”

He had begun to push his family away, his sister said. He suffered from anxiety disorders and went to counseling . His appearance was changing in the year before his death; he wasn’t showering as much and was unshaven. He was combative and argumentative .

While Dirksen, a Sioux Falls lawyer now, knew that he brother was acting different, “this wasn’t even a fear of mine that he would do something like this,” she said. In fact, the night before he died, they were at their parents’ house, and she had been pushing him to buck up and turn his life around.

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“We had an argument,” Dirksen said. “I said, ‘Rob, you need to x, y and z. You need to grow up.’ He had stormed off and was upset with me. I remember him looking at me, and I think he thought I was disappointed in him. I think he thought we were frustrated with him and were kind of tired of him struggling. I don’t think he understood. I wish now I would have treated him differently.”

'No one ever gets over it'

Kittams-Lalley and Sandy Parham, a suicide and crisis support coordinator at the HelpLine Center, tell survivors such as Dirksen and Kruger and Harris and the others that anger, guilt and confusion are normal feelings, part of the mourning process. There is a healing power, they say, in tears.

But even in healing, no one ever really gets over the loss, survivors say.

“I’m sure if I live to be 90 years old, there will be days I will cry,” Wilson said.

That doesn’t mean she will be stuck forever in grief, Parham said. “It just means they’re living, and they’re still in a continued journey to healing,” she said. “No one ever gets over it. If they get the opportunity to talk about it and work through their grief, they can learn to live with it and can maybe thrive again, if they have hope.”

For those new to the journey, the Senftners and the Notebooms, there is a reassurance in that, though perhaps it is not so easy to see yet.

For the others, certainly “living with it” has become less difficult. But again, the scar on their heart does not go away. And their lives are not better, they say, because of what unquestionably is a selfish if not tormented act.

Angel Wilson sits in silence and wonders how her son’s life would have turned out. Jerry Cook and Lynette Kruger lament that their father and husband will miss graduations and weddings and births. Karen Krietlow and Mary Ellen Dirksen always will struggle to understand how a loved one could be in so much pain when they didn’t see it.

“What bothers me the most about her death is that I wish I could have saved her,” Janine Harris said of her daughter, Nikki. “I’m sure others that have gone through a situation like this feel the same way. I like to say I’ve learned to live with this, but that doesn’t mean that I don’t have my difficult times. I just miss her. And that’s the hardest thing of all.”